After diagnosis, several episodes, ECGs, echo cardiogram and CTscan, confirmed with paroxysmal AF and some furring of arteries but basically sound heart for a 72 year old. All usual meds prescribed, BP , betablocker, statin, anticoagulant (on top of T2 diabetes insulin regime). Cardiologist washed his hands and passed back to GP recommending flecainide if it gets worse. Maybe my poor old brain hasn't quite grasped it all, but what isn't too clear to me is what do I do at the next AF episode (assuming it's pretty much same as the ones before)? Nothing? I know what it is and it will pass of its own accord. Tell the GP? Suspect they will just suggest I go to A+E. Go to A+E? Is there any more they can actually do? And I really don't fancy an 8 hour wait like last time when I was then sent home after a 10 min chat with a very busy medic who said there was not much they could do and it would just pass, and to contact GP if I was still worried. I'm not trying to criticise the NHS but I'm not sure I'm sure about the right course of action. Any advice or recommendations?
Living with AF...and then what? - Atrial Fibrillati...
Living with AF...and then what?
AF is a chronic conditon not an accident nor emergency and should be treated as such by your doctor(s). Of course the exceptions are if you have any chest pain, difficulty breathing or any fainting with it in which case contact emergency services. As my consultant told me many years ago the three things to remember about AF is It won't kill you, it won't kill you and it won't kill you. Might feel like it sometines though!
It is also important to understand and accept that any and all treatment for AF is only for quality of life (QOL). Thre is no best treatment so long as the patient is anticoagulated for stroke prvention (the greatest risk with AF). Rhythm control may be the hope but so long as rate is well controlled there is no difference in outcome. If neither rate nor rhythm control appear to work then you can ask to be reffered to a rhythm speciaist (An electrophysiologist, a cardiologists who specialises in arrhythmias) who may offer an ablation to try and stop the rogue impulses by blocking them with scar tissue, either with heat or cold but again it is important to know that whilst primarily a safe procedure (I had three before my AF was finally terminated) they are not without risk and recovery may be harder than you think or are told.
Finally go to AF Association main website and read all you can as knowledge is power.
You need a plan and instructions from your cardiologist and/or ep In Advance. The plan could be instructions of what medications to take to lower your heart rate and/or convert to sinus rhythm and when to call them if you don't. Since they seem to think you qualify for Flecainide, I would get that prescription now, with specific instructions how to use it in case you go into afib.
With a plan, you can usually avoid the A&E. Without a plan, the A&E is your only option, because you do not want to remain at a high heart rate any longer than necessary, nor do you want to remain in afib longer than necessary. Neither is good for your heart.
Jim
have asked this question a few times to my gp and cardio doctor but never really got a clear answer.............
How you deal with PAF is you build general knowledge & then add on experience of your personal situation. No short cuts to this that I know of. There is so much going on in the early days of diagnosis that it is very easy to be 'dumped', missing something and only realising it later.
I would suggest if funds allow it is money well spent to make a private appointment with the cardiologist (if you got on) or another, armed with your list of Q's, one of which should be 'If I should need Flecainide, is that to be trialled whilst in hospital' - it is likely to be OK for most but can be a problem for a few.
If you self convert back to NSR then you would be better off staying at home and learning to relax and "ride it out". Presumably when you got sent home from A&E you were still in afib and had to do that anyway. If you are considered a good candidate for Flecainide that would hopefully stop it . You could take this as a PIP or as a preventative daily dose . It might depend on how frequent your episodes were. I never go to hospital with my afib. I am not too symptomatic and sitting for hours on a torturous seat in a waiting room surrounded by a lot of sick people would stress me out far more than waiting for it to pass at home.
I've never knowingly done a self conversion, just waited for it to happen. Interested in trying the manoeuvre next time to see if you can actually turn it off. Going to A+E is the very very last option. The cardiologist has advised GP flecainide is an option in future if symptoms are intrusive. Let's see. Let the cake bake.
I meant "self conversion " as it just stopping without outside medical interference ! JeanJeanie has posted a list of manouvres that can halt the episodes . Whether they work or not seems to be luck!
It sounds as if your cardiologist has left the decision about taking Flecainide to you - and has authorised your GP to prescribe it if you feel you need it. I find that approach very strange but presumably, it works.
Regarding A&E, it depends on your symptoms - chest pain, severe breathlessness - yes, A&E. If you self convert to sinus rhythm in a few hours and feel reasonably 'well' you have to balance the misery of getting to A&E, the wait, the stress and the fact that probably nothing will be done for you with the comfort and quiet of your home. I used to lie on my right side, breathe evenly and think nice thoughts during episodes.
I agree with other posters that a plan of action on your part will give you the ability to deal with your AF and learn more about your ability to cope with episodes. I got totally fed up with the interference in my life that AF caused and I did what secondtry suggests and saw an EP privately.
Take it a day at a time, read all you can and ask any questions you may have - someone will be able to help.
I have paroxysmal afib with a fast ventricular rate and would go to the Emergency room and get a cardio version which put me in sinus rhythm every time. It would last about a month.. After the fourth trip, I told my cardiologist that I needed a plan. He sent me to an Electrophysiologist wh started me on an anti arrhythmic which wasn’t working. So our next step was an abalation. So far it’s working!
Crikey! Another post that could have been written by me! I’ve got a good heart and PAF
I too have sat in A&E many times - staff just sitting for the AF to go away if it’s own accord. Got told in the end to go home and just “ride it out” and only come in if I’ve got “chest pain, dizziness, the usual”.
GP admits openly that he’s not a cardiologist. Got prescribed Digoxin and Flecainide over the phone by the cardiology nurse - even the NHS website says first doses of BOTH these drugs should only be administered in the presence of a doctor. Told her I live alone alone and there’s no one to see me hit the floor and she just said “I’m sure you’ll be ok”.
I’ve been forced to pay privately to see a cardiologist simply to get more information.
The NHS is a mess! They’re recommending a pacemaker and ablate as they can’t provide a more simple ablation procedure to see if that works first because the wait time is 9+ months!
It's been heading this way for quite some time, well before scapegoats like Covid and Putin. If I believed in conspiracy theories I'd be suspicious it's deliberately being allowed to happen , like the dentistry nightmare, to push more people into private treatment and lighten the burden on the government (although any savings will only go into another war and/or someone's back pocket...oh don't get me started!)
It’s been called stealth privatisation. Which is ok if you’re young and can get cheap insurance, but for us older people with pre-existing conditions, we’re going to fall into a chasm where nobody is providing our healthcare. That’s my theory anyway.
I felt myself in a similar position this afternoon but I took a bisoprolol and am currently waiting for my pulse to drop to normal. I only take it as and when needed, and it takes 1-2 hours to begin to work. With only a 1.25mg tablet, my pulse is now at 95bpm down from 180bpm an hour and a half ago.
I would speak to your GP as he or she will have a useful experience of hundreds of different patients with AF. I was told by mine to take up to 5mg bisoprolol but even 2.5mg drops my rate to 40 or so a day later, so I’m trying to stick to the lowest dose. I’ll be phoning my surgery tomorrow (assuming things settle well).
Steve
PS Normal service was resumed after exactly two hours. Thank goodness.
Glad to hear your strategy worked. I was originally prescribed bisoprolol but had problems with diarrhea and was switched to atenolol 100mg once per day, every day. I think it's high because I was struggling to get high blood pressure down at the time. Did the trick but pulse rate now averages low 50s. Give with one hand, take away with the other. Funny how we're all different. No wonder the medics struggle to get the right balanced treatment for everyone.
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